Results to a survey of extent of and response to research misconduct in low- and middle-income countries.

<p>NIH, National Institutes of Health.</p

Ratio of retractions for fraud to total number of papers published for selected countries.

<p>Ratio of retractions for fraud to total number of papers published for selected countries.</p

Using a Low-Sodium, High-Potassium Salt Substitute to Reduce Blood Pressure among Tibetans with High Blood Pressure: A Patient-Blinded Randomized Controlled Trial

<div><p>Objectives</p><p>To evaluate the effects of a low-sodium and high-potassium salt-substitute on lowering blood pressure (BP) among Tibetans living at high altitude (4300 meters).</p><p>Method</p><p>The study was a patient-blinded randomized controlled trial conducted between February and May 2009 in Dangxiong County, Tibetan Autonomous Region, China. A total of 282 Tibetans aged 40 or older with known hypertension (systolic BP≥140 mmHg) were recruited and randomized to intervention (salt-substitute, 65% sodium chloride, 25% potassium chloride and 10% magnesium sulfate) or control (100% sodium chloride) in a 1: 1 allocation ratio with three months’ supply. Primary outcome was defined as the change in BP levels measured from baseline to followed-up with an automated sphygmomanometer. Per protocol (PP) and intention to treat (ITT) analyses were conducted.</p><p>Results</p><p>After the three months’ intervention period, the net reduction in SBP/DBP in the intervention group in comparison to the control group was −8.2/−3.4 mmHg (all p<0.05) in PP analysis, after adjusting for baseline BP and other variables. ITT analysis showed the net reduction in SBP/DBP at −7.6/−3.5 mmHg with multiple imputations (all p<0.05). Furthermore, the whole distribution of blood pressure showed an overall decline in SBP/DBP and the proportion of patients with BP under control (SBP/DBP<140 mmHg) was significantly higher in salt-substitute group in comparison to the regular salt group (19.2% vs. 8.8%, p = 0.027).</p><p>Conclusion</p><p>Low sodium high potassium salt-substitute is effective in lowering both systolic and diastolic blood pressure and offers a simple, low-cost approach for hypertension control among Tibetans in China.</p><p>Trial Registration</p><p>ClinicalTrials.gov <a href="http://clinicaltrials.gov/ct2/show/NCT01429246?term=NCT01429246&rank=1" target="_blank">NCT01429246</a></p></div

Trial Flow Chart.

<p>Trial Flow Chart.</p

Distribution of Blood pressure at baseline and follow-up, per-protocol analysis.

<p>Distribution of Blood pressure at baseline and follow-up, per-protocol analysis.</p

Blood pressure at baseline and follow-up, reduction of blood pressure in each group and net reduction of blood pressure in salt substitute group in comparison with regular salt group.

<p>All numbers shown are mean (SD) except for the △2 that is shown in mean (SE).</p>a.<p>Mean reduction of blood pressure in each group after intervention.</p>b.<p>Net reduction of blood pressure in salt-substitute group in comparison with regular salt group, adjusting for baseline blood pressure, sex, age, township, baseline BMI and using blood pressure lowering agents.</p>c.<p>impute 10 times.</p><p>Blood pressure at baseline and follow-up, reduction of blood pressure in each group and net reduction of blood pressure in salt substitute group in comparison with regular salt group.</p

Baseline characteristics of study participants by randomized group.

<p>All numbers shown are mean (±SD) unless otherwise noted as number (%).</p><p>All p-values comparing the two groups are larger than 0.05.</p>a.<p>According to the American Heart Association, stage 1 hypertension was defined as 140≤SBP<159 and/or 90≤DBP<100; stage 2 hypertension as SBP≥160 and/or DBP≥100.</p>b.<p>Other occupation includes farmer, doctor, self-employed and retired.</p>c.<p>Participant who have smoke more than 20 packs in life or smoke at least one cigarette per day and last more than one year was regarded as having smoking history.</p>d.<p>Participant who drinks at least once per week was regarded as having drinking history.</p><p>Baseline characteristics of study participants by randomized group.</p

Decision tree structure of the Markov model for each arm (usual care, School-EduSalt program).

<p>Decision tree structure of the Markov model for each arm (usual care, School-EduSalt program).</p

Costs of School-EduSalt intervention including set-up costs and running the program for 1 semester.

<p>Costs of School-EduSalt intervention including set-up costs and running the program for 1 semester.</p

The values of input parameters for Markov models.

<p>The values of input parameters for Markov models.</p